Wednesday, October 11, 2017

Florida lawmakers hear grim picture of opioid epidemic

Facing what one expert called “chemical warfare,” a key Senate panel Tuesday began tackling the opioid crisis that has engulfed the nation and state, ripped families apart and created a public health crisis bound to get worse.

The Senate Health Policy Committee heard from a panel of experts —- including emergency doctors, treatment providers, law enforcement officials and insurance company executives —- who laid out a litany of woes detailing the severity and complexity of the opioid epidemic, which prompted Gov. Rick Scott to declare a public emergency.

Testimony from the experts made a chilling impression on the committee.

Abuse of prescription painkillers along with fake street pills and street drugs such as heroin and the synthetic opioid fentanyl —- and the deaths associated with the drugs —- has skyrocketed since lawmakers cracked down on “pill mills” six years ago.

There aren't enough treatment beds. Access to medically assisted treatment —- where addicts receive drugs and other services, such as cognitive behavioral therapy —- is limited. A stigma associated with addiction keeps many users in the shadows. The system is disjointed, making it difficult for addicts and their families to navigate.

And nearly all the entities involved —- physicians, treatment providers and sheriffs and police departments —- are struggling to make do with scarce resources as the number of addicts continues to skyrocket.

“Currently, it's much easier to get high than it is to get help in Florida,” Aaron Wohl, an emergency room physician from Lee County, said.

Scott has said he will ask lawmakers in 2018 to spend $50 million on programs such as substance-abuse treatment, counseling and recovery. He also is proposing a three-day limit on new prescriptions for opioids, though the prescriptions could be up to seven days under some conditions.

But the prescription-drug limits are mainly a “feel-good” measure that won't address the larger problem of addiction and access to street drugs, such as heroin and fentanyl, experts agreed.

“To focus on the flow of medications and creating new persons with addiction is certainly one issue that's important and we want to help with that, but to ignore those persons that are actually addicted currently, and the medications that they're overdosing on, being heroin and illicitly manufactured fentanyl, then we're missing the point,” Wohl told reporters after Tuesday's meeting.

An interim report by the state's medical examiners covering the first six months of 2016 showed a 13.9 percent increase in drug-related deaths, compared to the first half of the previous year.

Fentanyl was the top killer, followed by benzodiazepines, morphine and heroin, according to the report. Deaths caused by fentanyl increased by nearly 140 percent, and accidental deaths from heroin overdoses jumped by 25 percent, compared to the same six-month period in 2015.

The situation is even more dire than the report suggests, as medical examiners struggle to keep pace as demands for autopsies skyrocket because of overdoses.

“Scrap your numbers. They're meaningless because they are so under-quoted,” said Raymond Pomm, a doctor with more than 30 years of experience in the substance-abuse field who now serves as the medical director of Gateway Community Services in Jacksonville. “I'm sorry to say whatever numbers you have, they're far, far worse. Never have we ever seen anything like this.”

Medical examiners in the Jacksonville area have asked Pomm's agency to provide naloxone, also known as Narcan, a prescription medication that can reverse opioid overdoses. The coroners want access to the treatment because of their exposure to fentanyl. Even miniscule amounts of the synthetic opioid, often mixed with heroin, can be deadly when inhaled or absorbed through the skin.

“It's more than an epidemic. It's become chemical warfare,” Pomm said. “It's become a gnarly system that's entwining every aspect of our society.”

Making matters worse, users can purchase fentanyl on the internet, Volusia County Sheriff Michael Chitwood told the committee.

Correcting the “legal” side of opioid abuse is only part of the problem, said Kenneth Scheppke, medical director for Palm Beach County Fire Rescue and a medical director for emergency medical services in Broward County.

“If we don't address the treatment side, the addicts will turn to a different source. They will turn to street drugs,” he said.

While the use of naloxone is rapidly increasing, reviving patients who've overdosed —- some of whom receive more than one dose of the drug in a single day —- does nothing to cure the problem.

Palm Beach County has launched a pilot program in which emergency-room patients who've overdosed on opioids are connected while in the hospital with a detox program, using the drug buprenorphine, also known as Suboxone, that reduces cravings and eases withdrawal symptoms without getting patients high.

Patients in the program also receive behavioral counseling, which experts agree is a critical part of treating addiction, in combination with medications like Suboxone.

The pilot program, with 50 participants, has a 76 percent success rate, according to Scheppke.

The program is a stark contrast to the “revolving door” encountered by most users.

Patients overdose, are saved by Narcan and sent to the emergency room, where they are released to go home and relapse again.

“Nothing's really done,” Scheppke said. “What we have basically is the patients treating themselves as best as they can.”

Monday's testimony struck a chord with Senate Health Policy Chairwoman Dana Young, who made an impassioned pledge at the close of the 2½- hour meeting.

“You said it was easier to get high than to get treatment. That needs to stop. That needs to stop today. And it is within our power as a legislature to make that happen. While it can be exhausting and frustrating to deal with this issue, I will tell you that we are not exhausted, as a committee, as a Senate, as a legislature. We are determined to tackle this problem any way we can,” Young, R-Tampa said.

Young told reporters she was impressed by Scheppke's pilot program and that it was “abundantly clear” that the Legislature needs to fund medically assisted treatment programs statewide.

“I have no idea how much that's going to cost, but we need to figure it out, and we need to find the money to do it,” she said.